Dental Solutions of South Florida — Website Visual Reference Page 7 · Sleep Apnea
348 Alhambra Circle, Coral Gables (305) 447-9199 dentistry@lesliehallerdmd.com
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# Sleep Disordered Breathing & Sleep Apnea — alternatives that may eliminate CPAP

CPAP is effective — but half of patients abandon it within three years. Dr. Haller offers custom oral appliances and permanent, non-surgical airway expansion that treat the anatomy causing sleep apnea, not just the symptoms.

Custom oral appliances
Permanent airway expansion
Board Certified in Dental Sleep Medicine
1 in 5
adults has at least mild sleep apnea — most undiagnosed
50%
of CPAP users abandon it within 1–3 years
3×
higher risk of heart disease with untreated sleep apnea
7.7
24.1 cm² airway growth possible with permanent expansion
Understanding sleep apnea
What is sleep apnea — and could you have it without knowing?
Sleep apnea is not just loud snoring. It is a condition in which the airway partially or fully collapses during sleep — starving the body of oxygen dozens or even hundreds of times per night. Most people with sleep apnea have no idea they have it.
OSA — Obstructive Sleep Apnea
The most common form. The airway physically collapses during sleep — usually at the level of the tongue, soft palate, or tonsils. The brain rouses the body to restore breathing, often dozens or hundreds of times per night without the patient waking fully or remembering it.
Obstructive sleep apnea is the most common form of sleep apnea.
UARS — Upper Airway Resistance Syndrome
Frequently missed, especially in women. The airway doesn't fully collapse, but airflow is significantly restricted — causing micro-arousals and fragmented sleep. AHI scores are often normal, leading physicians to miss the diagnosis entirely.
Often misdiagnosed as anxiety or insomnia
CSA — Central Sleep Apnea
Less common. The airway is open but the brain fails to send the signal to breathe. Often associated with heart failure, neurological conditions, or opioid use. Requires medical management in addition to dental treatment.
Less common · Medical co-management required
The UARS patient — often told their sleep is fine
UARS patients often have normal weight, no dramatic snoring, and normal AHI scores on a sleep study. They are told their sleep is fine — but they feel exhausted, anxious, and wired-but-tired. They may have been diagnosed with anxiety, depression, fibromyalgia, or chronic fatigue syndrome when the root cause is actually a breathing disorder during sleep. Dr. Haller specifically evaluates for UARS, which is frequently overlooked in conventional sleep medicine.
The mechanism
What happens during an apnea event
1
Muscles relax
During sleep, the tongue and soft palate muscles relax. In a normal airway, there is enough space. In a narrow airway, relaxed muscles can cause a collapse which closes off the space either partially or entirely.
2
Airway collapses
The tongue falls back, the soft palate drops, and the airway closes — partially or fully. Airflow stops.
3
Oxygen drops
Blood oxygen saturation falls. In severe cases, it may drop to dangerous levels — putting enormous strain on the heart and brain.
4
Brain sounds alarm
The brain detects the oxygen drop and triggers an arousal — a micro-awakening that restores muscle tone and opens the airway. The patient rarely wakes fully or remembers it.
5
Cycle repeats
This cycle may repeat 5–100+ times per hour all night, every night — preventing deep restorative sleep and stressing every organ system.
"Sleep apnea is usually a structural problem — the airway is too small. CPAP holds it open with air pressure, which is effective but requires the machine every night for life. What I do is different: I treat the anatomy itself, to create an airway that stays open on its own."
— Dr. Leslie Haller, DMD
Do you recognize these?
Sleep apnea symptoms — many you wouldn't expect
Most people think sleep apnea means loud snoring and daytime sleepiness. In reality, it presents in dozens of ways — many of which are routinely misattributed to other conditions.
Classic sleep symptoms

- Loud or chronic snoring
- Gasping or choking during sleep
- Witnessed apneas (partner reports you stop breathing)
- Waking unrefreshed despite 7–8 hours
- Excessive daytime sleepiness
- Falling asleep at inappropriate times
- Morning headaches
- Dry mouth or sore throat on waking

Pain & structural signs

- Bruxism (teeth grinding) — jaw thrusting forward to open airway
- TMJ pain or jaw clicking
- Frequent nighttime urination (nocturia)
- Acid reflux — negative thoracic pressure pulls stomach acid upward
- High blood pressure — especially resistant to medication
- Chronic neck or shoulder pain
- Forward head posture

Cognitive & emotional

- Brain fog, poor concentration
- Memory problems
- Mood swings, irritability
- Depression or anxiety — often improve once sleep is restored
- ADHD-like symptoms (especially in children)
- Reduced libido
- Weight gain despite diet & exercise

Why these happen
The surprising symptoms — and their mechanisms
Bruxism (teeth grinding)
When the airway narrows, the jaw subconsciously thrusts forward during sleep to open it. This continuous jaw movement causes grinding and clenching — destroying tooth enamel and straining the TMJ. Treating the airway often resolves bruxism without a night guard.
Nocturia (nighttime urination)
Repeated oxygen deprivation causes the heart to produce atrial natriuretic peptide (ANP) — a hormone that signals the kidneys to produce urine. Many patients with nocturia have sleep apnea as the root cause, not an overactive bladder.
Acid reflux (GERD)
Each time the airway collapses, the diaphragm creates massive negative pressure trying to pull air in. This pressure pulls stomach acid upward through the esophageal sphincter. Many patients treated for GERD actually have undiagnosed sleep apnea.
Weight gain
Sleep deprivation disrupts leptin (the "I'm full" hormone) and ghrelin (the "I'm hungry" hormone). Poor sleep drives cravings for high-carb foods, reduces motivation to exercise, and lowers metabolism. Many patients find weight management dramatically easier once sleep is restored.
Depression & anxiety
The brain cannot regulate mood without adequate deep sleep. Many patients diagnosed with depression or anxiety see significant improvement once their sleep disorder is treated — without changing their psychiatric medications. The wired-but-tired feeling of UARS is particularly often mistaken for anxiety.
Resistant hypertension
Repeated oxygen drops overnight trigger the sympathetic nervous system — raising blood pressure. Many patients on two or three blood pressure medications have undiagnosed sleep apnea as a contributing cause. Treating sleep apnea can meaningfully reduce blood pressure.
The stakes
Untreated sleep apnea is a serious medical condition
Every night of untreated sleep apnea is a night of repeated oxygen deprivation, cardiovascular stress, and hormonal disruption. Over years and decades, the cumulative damage is significant — and most of it is preventable.
Cardiovascular

- 3× higher risk of heart disease
- 2–4× increased stroke risk
- Atrial fibrillation
- Resistant hypertension
- Heart failure progression

Metabolic

- Type 2 diabetes risk
- Insulin resistance
- Weight gain cycle
- Metabolic syndrome
- Chronic inflammation

Neurological

- Accelerated cognitive decline
- Dementia risk
- Depression & anxiety
- ADHD-like symptoms
- Memory impairment

Safety & quality of life

- 7× increased car accident risk
- Reduced work performance
- Relationship strain
- Reduced intimacy
- Shortened life expectancy

The most dangerous thing about sleep apnea is not knowing you have it
Most people with sleep apnea are never diagnosed. They attribute their symptoms — fatigue, mood problems, weight gain, brain fog — to stress, age, or lifestyle. Meanwhile, the cumulative oxygen deprivation is quietly damaging the heart, brain, and metabolic system. Early diagnosis and treatment can reverse much of this damage — and dramatically improve quality of life.
In children — the stakes are even higher
Sleep apnea in children looks different
Children with sleep apnea rarely present with daytime sleepiness — they become hyperactive, inattentive, and aggressive instead. An enormous proportion of children diagnosed with ADHD have an underlying sleep-disordered breathing issue. Treating the airway can transform behavior and academic performance.
Facial development consequences
Mouth breathing during childhood actively reshapes the face — narrowing the palate, lengthening the face, and crowding the teeth. These structural changes reduce the airway permanently. Early intervention with appliances like Healthy Start can reverse this trajectory.
Signs of sleep-disordered breathing in children

- Snoring — any snoring in a child warrants evaluation
- Mouth breathing — day or night
- Bedwetting beyond expected age
- Night terrors or frequent waking
- Behavioral problems, ADHD diagnosis
- Poor academic performance
- Dark circles under eyes ("allergic shiners")
- Crowded teeth or narrow palate
- Long, narrow face

The earlier we treat, the better the outcome
Children's facial bones are still growing and highly responsive to expansion appliances. Treating sleep-disordered breathing in childhood can prevent a lifetime of airway problems — and avoid surgery entirely.
Your options
CPAP works — but you have real alternatives
CPAP is the gold standard for moderate-to-severe OSA — highly effective when worn. The problem is compliance. Half of patients abandon it within one to three years. Dr. Haller offers two alternatives: a custom oral appliance (MAD device) for nightly use, and permanent airway expansion that may eventually eliminate the need for any device at all.
CPAP
Delivers pressurized air through a mask to hold the airway open. Highly effective — but a maintenance device only. Must be worn every night for life. Stop using it and apneas return immediately.
Why patients abandon it:
Mask claustrophobia Noise Dry mouth Travel difficulty Intimacy impact Maintenance burden
Custom MAD device
A custom-fitted oral appliance holds the lower jaw slightly forward during sleep — keeping the tongue and soft palate from collapsing into the airway. Silent, small, portable, and far easier to tolerate than CPAP.

- No mask, no noise, no machine
- Fits in a pocket when traveling
- Adjustable over time for optimal position
- Higher real-world compliance than CPAP
- Best for mild-to-moderate OSA

Permanent airway expansion
Epigenetic appliances (Vivos, Homeoblock, AMD, clear aligners, and other methods) physically enlarge the palate and nasal passages — creating a permanently larger airway. The only approach that treats the anatomy, not just the symptom.

- No nightly device once complete
- Structural change — not maintenance
- 12–24 month treatment period

Side by side

Feature | CPAP | MAD Device | Permanent Expansion
--- | --- | --- | ---
Mechanism | Air pressure splints airway open | Jaw position holds airway open | Airway is permanently enlarged
Nightly use required | Every night, for life | Every night, for life | No — airway stays open naturally
Noise | Yes — disturbs partner | Silent | Silent
Travel | Requires machine + power | Small, portable | No device needed
Compliance | 50% abandon within 3 years | Much higher than CPAP | Treatment period only
Treats anatomy | No — maintenance only | No — maintenance only | Yes — permanent structural change
Best for | Moderate-severe OSA, high compliance | CPAP-intolerant, mild-moderate OSA | Long-term resolution, motivated patients

Photo: custom MAD device
Replace with product photo of custom oral appliance
Insurance note for MAD devices
Our practice is fee-for-service. For custom MAD devices, we provide all necessary codes for you to submit to your medical insurance directly. Many medical plans reimburse custom oral appliances for diagnosed OSA. A sleep study diagnosis is generally required prior to coverage.
What the research shows — and what it doesn't guarantee
Published studies on custom MAD devices are encouraging. In prospective research, MADs reduced AHI in approximately 93% of patients, with around 69–72% achieving clinically meaningful improvement (defined as ≥50% reduction in apnea events). Over 96% of patients in a 5-year follow-up study wanted to continue therapy — far better than CPAP's real-world abandonment rate. That said, results vary by individual. Success rates are highest for mild-to-moderate OSA and lower for severe cases. A MAD is not a guarantee — it is a well-supported, well-tolerated option that works well for many patients, and Dr. Haller will evaluate whether you are a good candidate before recommending one.
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The long-term approach
Can sleep apnea be permanently resolved?
CPAP and MAD devices manage sleep apnea — they work only when worn. For patients who want to address the underlying anatomy, Dr. Haller offers a more comprehensive approach that goes beyond nightly devices.
Epigenetic arch remodeling
The dental arches can be gradually expanded using custom oral appliances — widening the palate, opening the nasal passages, and creating a structurally larger airway. Dr. Haller has trained extensively with the leading innovators in this field and uses a range of appliance systems tailored to each patient's anatomy and goals.
Tongue tie evaluation
A restricted tongue cannot rest in its correct position on the roof of the mouth — forcing low tongue posture, mouth breathing, and airway narrowing. Dr. Haller evaluates every sleep apnea patient for tongue tie, as releasing it is often the upstream fix that makes everything else work better.
Myofunctional therapy
Myofunctional therapy retrains the tongue, facial, and throat muscles to support nasal breathing and correct tongue posture. When combined with arch expansion and tongue tie release, it reinforces structural changes and helps results last. Dr. Haller coordinates myofunctional therapy referrals as part of a comprehensive airway plan.
⏱ A realistic picture of what's possible
Epigenetic arch remodeling typically takes 12–24 months. Results develop gradually and continue even after treatment ends. Many find they need less — or no — nightly device once the airway has been permanently enlarged. Individual results vary depending on starting anatomy, age, and commitment to the full treatment plan. Dr. Haller will give you an honest assessment of what is realistic for your specific situation.
Frequently asked questions
Your questions answered
Do I need a sleep study before I can be treated?
For a custom MAD device, a sleep study diagnosis is generally required before medical insurance will cover treatment. For evaluation purposes, Dr. Haller can assess your airway and discuss options at consultation. We can help coordinate a home sleep test if you haven't been diagnosed yet — these are convenient, done in your own home, and far less expensive than an in-lab study.
Is a MAD device as effective as CPAP?
For mild to moderate OSA, research shows MAD devices achieve comparable outcomes to CPAP — and significantly better real-world results because patients actually wear them consistently. CPAP is more effective on paper; MAD devices are more effective in practice for many patients. For severe OSA, CPAP remains the stronger option, though MAD is still preferable to no treatment at all.
Can sleep apnea be cured — or only managed?
CPAP and MAD devices manage sleep apnea — they work only when worn. Permanent airway expansion is the only approach that can genuinely resolve the structural cause. Many patients who complete a full expansion protocol find they no longer need any device. Results vary by individual, starting anatomy, and compliance with treatment.
I was told I have mild sleep apnea and don't need treatment. Is that true?
Even mild sleep apnea carries real health consequences over time — and tends to worsen with age and weight changes. More importantly, mild sleep apnea on a conventional AHI-based study may actually represent UARS, which is significantly underdiagnosed. If you have symptoms — fatigue, brain fog, waking unrefreshed — it is worth a thorough evaluation regardless of what the AHI number says.
I've tried a MAD device before and it hurt my jaw. Can I still try again?
Yes — often. Many patients who struggled with earlier appliances had poorly fitting or improperly calibrated devices. Custom-fitted appliances with careful titration are dramatically more comfortable. Dr. Haller also evaluates the jaw joint before recommending any appliance — if there is existing TMJ dysfunction, that is addressed as part of the treatment plan.
Does insurance cover these treatments?
Our practice is fee-for-service. For custom MAD devices, we provide all necessary codes for submission to your medical insurance — many plans reimburse custom oral appliances for diagnosed OSA. Expansion appliances are generally not covered by insurance. We provide a Letter of Medical Necessity and can discuss payment options at consultation.
My partner says I snore but I don't feel tired. Should I be concerned?
Yes. Many people with significant sleep apnea don't feel sleepy — they've adapted to their baseline level of sleep deprivation and don't recognize it as abnormal. Snoring is always a sign of airway turbulence and worth evaluating. And the cardiovascular consequences of untreated sleep apnea occur regardless of whether you feel tired.
Patient stories
What our patients say
★★★★★
"I tried CPAP for two years and couldn't tolerate it. Dr. Haller made me a custom oral appliance and I sleep through the night for the first time in a decade."
Robert M.
Sleep Apnea · Oral Appliance
★★★★★
"I had been told my sleep study was 'borderline' and nothing was done. Dr. Haller recognized UARS immediately. Six months into expansion therapy I feel like a different person."
Sandra K.
UARS · Airway Expansion
★★★★★
"My husband slept in another room for three years because of my snoring and CPAP noise. After 18 months of expansion therapy we sleep in the same room again — no CPAP, no snoring."
Patricia L.
Sleep Apnea · Permanent Expansion